Services for severely head-injured patients in North London and environs

Abstract

There is a growing awareness of deficits in service provision for severely head-injured patients. This study identifies areas in which patients fail to receive services by investigating the admission and transfer of such patients from eleven District Health Authorities in North London and the services offered by rehabilitation professionals in hospital and community. Sixty per cent of our sample were referred to Neurosurgical Units (NSUs) and later transferred to District General Hospitals (DGHs). Of these, 20% remained in DGHs without receiving NSU care, while 20% were treated at NSUs but were not referred to a local DGH. Assessment of rehabilitation services revealed that on average physiotherapists offered the greatest amount of therapy time to head-injured patients (3-4 hours) per week compared with other professionals and that this seemed to be a reflection of referral systems. Of the patients in our sample approximately 80% received physiotherapy, 30% received occupational therapy and less than 15% received speech therapy, social work or clinical psychology. It was concluded that severely head-injured patients fail to receive available services due to haphazard admission and transfer procedures, lack of referral to rehabilitation professionals and to the paucity of appropriate community care.

The long-term outcome of head injury: Implications for service planning

“…That so many are handicapped, particularly in how they occupy their time, begs the question of what would happen if appropriate rehabditation facilities had been available to these patients earlier in their recovery process. Current work suggests that head-injured patients are particularly disadvantaged in this respect, with patients &ling to receive available services due to haphazard admission and transfer procedures, lack of referral to rehabilitation professionals, and to the paucity of appropriate community care [19]. One recent survey found that only 11% of districts reported specialist clinics for assessment, advice and review of people with head injury [20].…”

Effects of case management after severe head injury

“…At the same time we evaluated service provision after severe head injury in 11 hospitals and districts that fed into two neurosurgical units in north London 5. We used these results to select two groups of three hospitals with roughly similar services and populations for the present study.…”

Brain injury case management: the potential and limitations of late-stage intervention--a pilot study

“…The exception, Client 9 (Isaac), resulted in positive co-operation between case manager, NHS clinical psychology and psychiatry and the voluntary sector-Headway. This type of collaboration appears to be the exception, a finding implicit in Murphy et al [1].…”

“…The original pioneering studies in London emphasized the lack of resources to meet the longterm clinical and social needs of the severely brain-injured patient: Murphy et al [1] reported that over 80% of the severely head-injured in one London district had no contact with community resources 1 year after severe brain injury. The team involved in that study went on to explore the impact of one possible resourcecase management-for the severely head-injured [2].…”